Minimally invasive surgical versus transcatheter aortic valve replacement: A multicenter study

Abstract

Objectives Treatment of aortic valve stenosis is evolving, indications for transcatheter approach (TAVI) have increased but also surgical valve replacement has changed with the use of minimally invasive approaches. Comparisons between TAVI and surgery have rarely been done with minimally invasive techniques (mini-SAVR) in the surgical arm. Aim of the present study is to compare mini-SAVR and TAVI in a multicenter recent cohort. Methods Evaluated were 2904 patients undergone mini-SAVR (2407) or TAVI (497) in 10 different centers in the period 2011–2016. The Heart Team approved treatment for complex cases. The primary outcome is the incidence of 30-day mortality following mini-SAVR and TAVI. Secondary outcomes are the occurrence of major complications following both procedures. Propensity matched comparisons was performed based on multivariable logistic regression model. Results In the overall population TAVI patients had increased surgical risk (median EuroSCORE II 3.3% vs. 1.7%, p ≤ 0.001) and 30-day mortality was higher (1.5% and 2.8% in mini-SAVR and TAVI respectively, p = 0.048). Propensity score identified 386 patients per group with similar baseline profile (median EuroSCORE II ~3.0%). There was no difference in 30-day mortality (3.4% in mini-SAVR and 2.3% in TAVI; p = 0.396) and stroke, surgical patients had more blood transfusion, kidney dysfunction and required longer ICU and hospital length of stay while TAVI patients had more permanent pace maker insertion. Conclusions Mini-SAVR and TAVI are both safe and effective to treat aortic stenosis in elderly patients with comorbidities. A joint evaluation by the heart-team is essential to direct patients to the proper approach.

Minimally invasive surgery versus transcatheter aortic valve replacement: a systematic review and meta-analysis

“…Six studies 17–22 reported the outcome of stroke. We found no significant differences between TAVR and miAVR (RR: 1.08, 95% CI: 0.40 to 2.87, n=1588, I 2 =5%) with little evidence of heterogeneity; figure 4A .…”

“…Six studies 17–20 22 23 reported on AF outcome. Initially, our results showed no significant differences between the two groups in terms of the incidence of postoperative AF (RR: 0.37, 95% CI: 0.10 to 1.32, n=1514, I 2 =89%).…”

“…Six studies 17–22 reported on hospitalisation duration, with miAVR showing significantly longer durations as compared with TAVR (MD: 1.92, 95% CI: 0.61 to 3.24, n=1588, I 2 =95%), though high heterogeneity was observed. On excluding the TA cohorts of Zierer et al 20 and Bruno et al , 22 both of which had extreme values (the former in favour of TAVR and the latter in favour of miAVR), heterogeneity was resolved (MD: 2.00, 95% CI: 1.61 to 2.40, I 2 =0%).…”

“… 16 However, these may come at the cost of longer hospital stay durations and higher risk of AKI. 17 Aside from these differences, recent studies that compared the two approaches were controversial with regard to the superiority of either approach for stroke, 17–22 atrial fibrillation (AF), 17–20 22 23 and AKI 16–18 20 outcomes. To that end, we conducted the present systematic review and meta-analysis to compare the outcomes of TAVR and miAVR in the treatment of AS in the contemporary era.…”

Comparative outcomes in different aortic valve stenosis surgeries and implications of TAVR surgery for cirrhotic patients: A retrospective cohort study

“…We hypothesized that TAVR patients have decreased intra-operative complications, length of hospital stay, and develop fewer postoperative complications compared to patients who undergo SAVR and mini-SVR, as TAVR is less invasive and can obviate the need for cardiopulmonary bypass. Recently, it has been suggested that in patients who are at increased surgical risk, the decision between SAVR and TAVR should be made by the cardiology team according to individual patient characteristics [ 8 ]. We thus evaluated our patient population who had undergone one of these three surgeries with respect to their characteristics and surgical outcomes.…”